Hypotonic Duodenogram
This technique is used for mucosal detail and distensibility of the duodenum after an Upper GI study, Small bowel Follow Through or Small Bowel Enteroclysis.

This technique provides a two phase evaluation of the duodenum.
  1. Single contrast
     
  2. Double contrast phase using one of two methods
    • Air infused via a duodenal tube
    • Using air from effervescent granules and hypotonic agent


Technique:

A) HYPOTONIC DUODENOGRAM WITH INTUBATION

Usually done after small bowel Enteroclysis.

  1. Equipment:
    • Barium (Polibar)
    • Air
    • Duodenum intubated (8F Fredrick Miller feeding tube)
       
  2. The Technique:
    • The tube is withdrawn into the duodenum.
    • The hypotonic agent is given IM or IV
    • Small quantity of barium followed by air through the tube is instilled into the duodenum
       


B) HYPOTONIC DUODENOGRAM WITHOUT INTUBATION

This is done during an Upper GI study and especially when a duodenal lesion is suspected (from other studies such as CT scan)

  • Equipment:
    • Barium (EZHD)
    • Air from EZG gas effervescent granules
    • Use antispasmodic to get adequate hypotonia
       
  • The Technique:
    • The hypotonic agent is given IM or IV
    • Use the barium & air from the Upper GI study
    • Take the appropriate images (see below)


Radiographic Images Taken for Both Techniques:

  • Supine
  • Oblique
  • Decubitus (where possible)


Disadvantages:

  • Uncomfortable procedure for the patient when intubation used
  • GI Procedure times can be prolonged


Sample Radiographs:
 
Tube Hypotonic Duodenogram (Decibitus View)

Courtesy Dr. Art Zalev, University of Toronto		 Tubeless Hypotonic Duodenogram

Courtesy Dr. Lori Stewart, McMaster University